{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"Darlene F Robertson","gend":1,"currentgend":"","add":"112 MONROE ST","city":"Auburn","state":"ME","zip":"04210","dob":"1943-08-02","age":"","mstatus":"","insh":"10000037846","cliId":"","pno":2077825929,"cno":"","email":"DARFROB@AOL.COM","ename":"","eno":"","pphy":"CLOUTIER, LISE M","ppno":2077955700,"pcpadd":"12 HIGH ST,STE 400","pcpcity":"LEWISTON","pcpstate":"ME","pcpzip":"42407634","pcpcounty":"","pcpid":"","pcpname":"CENTRAL MAINE INTERNAL MEDICINE","plan":"Martin's Point","program":"MEDICARE","lob":"GA - 2025","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"112 MONROE ST","madd2":"","madd3":"","mcity":"Auburn","mstate":"ME","mzip":"04210","pcpfaxno":2077955727,"pcpnpi":1386624096,"currentgendcomment":"","pphycomment":"","uniqueid":"","medicareid":"3PN1AY8QY90","medicaidid":"","pcpFlag":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["E119","R600","R5381","Z794","I10","E039","E785","L989","M5450","Y042XXA","W19XXXA","T783XXD","Z4682","J90","G931","M549","L03119","L988","R609","I499","R001","M769","R5383","E1151","F325","T783XXA","I878","L570","X32XXXA","L821","R221","R6889","R109","M799","Z9049","K429","S3992XA","M47816","M4316","L299","H401133","H16223","Z0000","E1140","L820","L538","L298","R4781","K148","T782XXA","I493","R29818","Z0101","H26493","F329","R413","G252"],"date":["2025-11-17","2025-09-22","2025-09-09","2025-07-22","2025-09-02","2024-06-18","2025-07-22","2025-08-13","2023-04-29","2023-04-29","2023-04-29","2025-09-17","2025-08-19","2025-08-19","2025-10-17","2023-04-29","2025-06-18","2025-06-18","2024-05-02","2025-08-25","2025-08-25","2024-09-20","2023-04-27","2023-11-13","2023-11-13","2025-08-18","2025-07-09","2023-09-13","2023-09-13","2023-09-13","2025-08-18","2023-11-20","2023-04-29","2023-04-29","2023-04-29","2023-04-29","2023-04-29","2023-04-29","2023-04-29","2023-06-07","2024-12-13","2024-12-13","2025-03-25","2025-09-23","2023-06-07","2023-06-07","2023-06-07","2025-08-18","2025-08-18","2025-08-18","2024-05-06","2024-06-18","2023-05-02","2023-05-02","2022-11-09","2022-11-15","2022-11-15"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}},{"a":[]}]},{"t":"COVID Screening","q":[{"a":[]},{"a":[]},{"a":[]}]},{"t":"Self-Assessment and Social History (SDOH)","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Activities of Daily Living","q":[{"a":[]}]},{"t":"Medical History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Family History","q":[{"a":[]}]},{"t":"Preventive Care","q":[{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","","DONEPEZIL HCL","","","Select","Select",""],["","","HYDROCHLOROTHIAZIDE","","","Select","Select",""],["","","LISINOPRIL","","","Select","Select",""],["","","SYNTHROID","","","Select","Select",""],["","","ROSUVASTATIN CALCIUM","","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","GLIPIZIDE ER","","","Select","Select",""],["","","METFORMIN HCL ER","","","Select","Select",""],["","","TRESIBA FLEXTOUCH U-200","","","Select","Select",""],["","","HYDRALAZINE HCL","","","Select","Select",""],["","","ACCU-CHEK AVIVA PLUS","","","Select","Select",""],["","","ESCITALOPRAM OXALATE","","","Select","Select",""],["","","LEVOTHYROXINE SODIUM","","","Select","Select",""],["","","JANUVIA","","","Select","Select",""],["","","LEVEMIR FLEXPEN","","","Select","Select",""],["","","OZEMPIC","","","Select","Select",""],["","","LEVEMIR FLEXTOUCH","","","Select","Select",""],["","","TIMOLOL MALEATE","","","Select","Select",""],["","","SPIRONOLACTONE","","","Select","Select",""],["","","FLUOCINONIDE","","","Select","Select",""],["","","FLUZONE HIGH-DOSE QUAD 2023-24","","","Select","Select",""],["","","SPIKEVAX 2023-2024","","","Select","Select",""],["","","SHINGRIX","","","Select","Select",""],["","","ONETOUCH VERIO TEST STRIP","","","Select","Select",""],["","","ONETOUCH DELICA PLUS LANCET","","","Select","Select",""],["","","ONETOUCH VERIO FLEX METER","","","Select","Select",""],["","","CEPHALEXIN","","","Select","Select",""],["","","JARDIANCE","","","Select","Select",""],["","","PURE COMFORT LANCETS","","","Select","Select",""],["","","EASY TALK PLUS II","","","Select","Select",""],["","","EASY TALK","","","Select","Select",""],["","","EASY MINI EJECT LANCING DEVICE","","","Select","Select",""],["","","ALCOHOL SWABS","","","Select","Select",""],["","","ULTRA-FINE MINI PEN NEEDLE","","","Select","Select",""],["","","ZEGALOGUE AUTOINJECTOR","","","Select","Select",""],["","","ULTRA-FINE PEN NEEDLE","","","Select","Select",""],["","","TRIAMCINOLONE ACETONIDE","","","Select","Select",""],["","","ULTRA-FINE NANO PEN NEEDLE","","","Select","Select",""],["","","ONETOUCH ULTRA TEST STRIP","","","Select","Select",""],["","","ACCU-CHEK GUIDE ME GLUCOSE MTR","","","Select","Select",""],["","","METFORMIN HCL","","","Select","Select",""],["","","PEN NEEDLE","","","Select","Select",""],["","","FLUTICASONE PROPIONATE","","","Select","Select",""],["","","NANO 2ND GEN PEN NEEDLE","","","Select","Select",""]]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Assessment of Diagnoses","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["1",""],"comment":["",""],"sub":{"indx":[],"comment":[],"sub":[]}}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"a":[]},{"a":[]}]},{"t":"Home Safety & Personal Goals","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Active Problem Conditions","q":[{"a":[]}]},{"t":"Patient Summary","q":[{"a1":"","a2":"","a3":"","a4":"","a5":"","a6":"","a7":[],"a8":"","a9":"","a10":[],"a11":"","a12":"","a13":""}]}]}